Resident and Attending Physician Perspectives on Indirect Observation in Competency-Based Medical Education.

<b>Background</b> Despite calls for increased direct observation for workplace feedback and assessment, such forms of observation are not always feasible. A considerable amount of trainee observation occurs via indirect means. <b>Objective</b> To explore attending and resident perspectives on direct and indirect observation to determine their impact on workplace feedback and assessment. <b>Methods</b> Ten attending and 8 resident physicians were interviewed about their experiences and perspectives regarding direct and indirect observation. Data were collected from January to November 2021. Interview transcripts were analyzed using inductive thematic analysis. <b>Results</b> Major themes identified included: varying descriptions of direct and indirect observation, factors influencing the selection of observation type, the perceived utility of each observation type, and the perceived quality and credibility of feedback generated by each observation type. Direct observation was preferred for assessment of technical, communication, and leadership skills. Attending physicians felt they could provide an accurate assessment of the learner's clinical reasoning and management using indirect observation. However, residents did not consistently find the resultant feedback to be credible. This tension seemed to stem from residents not being aware of how indirect observation informed attending physicians' judgements and feedback. Residents with more insight on the use and methods for indirect observation perceived this feedback as credible. <b>Conclusions</b> Participants identified that indirect methods can be useful and appropriate for the assessment of clinical reasoning and for fostering independence. Residents demonstrating an understanding of how indirect observation informed attending physicians' assessments appeared to find this feedback more credible.